Mumps,meningitis,enceph

M U M P S Infectious Parotitis Epidemic Carlo Vincent J.

Definition - Is an acute, contagious infection that causes inflammation of the parotid gland.

Etiologic Paramyxo Virus. Agent Incubation 14-21 days. Period POC 7 days before and 9 days after the onset of parotid glands swelling

Mode of Transmission 1. Droplet contact 2. Indirect contact with objects contaminated with nasopharyngeal secretions. 3. Saliva is the source of infection.

Manifestations Remember: HEALS 1. Headache 2. Earache 3. Anorexia 4. Loss of Appetite 5. Swelling of the parotid gland

Diagnostic Test 1. Compliment Fixation Test 2. Hemo-agglutination Test 3. Neutralization Test 4. *Serum Amylase determination *Confirmatory Test

Local Measures 1. Isolate the patient 2. Paracetamol for fever 3. Advise soft diet 4. Advise not to apply indigo dye 5. Watch for warning signs

Complications Watch for warning signs: POEM a. Pancreatitis b. Orchitis/Oophoritis c. Encephalitis d. Myocarditis

Emergency Measures Assess ABC Start IV line <12 years old: D5 0.3 NaCl >12 years old: D5 NM O2 2-4 L/m via nasal cannula Diazepam maximum 10mg Refer to the hospital with referral letter

Prevention 1. Measles, Mumps, Rubella vaccine 1st dose: 12-15 months 2nd dose: 11-12 years old 2. Isolate the client and observe droplet precaution until 9 days after the onset of parotid swelling.

MENINGITIS Cerebrospinal Fever

Carlo Vincent J. Jordan

Definition - Inflammation of the meninges of the brain and spinal cord as a result of viral and bacterial infection. -

Dura matter Arachnoid Pia matter

Etiologic Agent • • • • • •

Pneumococcus Staphylococcus Streptococcus Tubercle bacillus *Neisseria Meningitides or Meningococcus- is the organism causing most epidemics of meningitis.

Incubation Period

1 to 10 days

Period of Communicability As long as causative agents are present in the discharges of the patient •

Mode of Transmission Respiratory Droplets

Diagnostic Test Bacterial Meningits • CBC: Increase polymorphonuclear leukocytes • CSF Analysis • Increase CSF pressure • Increase Protein • Increase Leokocytes • Decrease Glucose

Diagnostic Test

Viral Meningits • CBC: Decrease polymorphonuclear leukocytes • CSF Analysis • Normal or slightly increase CSF pressure • Normal or slightly Protein • Few Leukocytes • Normal Glucose

Manifestations

Classical Symptoms in Adult: • Fever, Headache, Nuchal rigidity • Altered Level of Consciousness • Petechial or Purpuric rashes

Manifestations

Classical Symptoms in Children: • Neck Tenderness, • Nuchal rigidity, • Bulging fontanels • High Pitched cry • Signs of Increased ICP • Signs of Meningeal Irritation: KNOB Kernig’s sign Nuchal rigidity Opisthotonus

Complications

Waterhouse Friedrichen Syndrome

Medical Treatment

Mannitol - is given to decrease cerebral edema Digitalis - is given to control arrythmias Antibiotics: - Ceftriaxone is given to combat causative agent Anti Convulsant - is given to control seizure

Nursing Management 2. Isolate the patient

3. Follow strict aseptic technique 4. Assess Level of consciousness 5. Check for signs of Increased ICP 6. Provide quite and noise free environment 7. Maintain Fluid balance

Prevention 2. Vaccination of HiB for children 3. Vaccination of Neisseria Menigitides Serogroups for older clients 4. Chemoprophylaxis: Rifampicin

ENCEPHALITI S Brain Fever Carlo Vincent J. Jordan

Definition - Inflammation of the cerebral tissue accompanied by meningeal irritation as a complication of infectious nervous system disease.

Classifications Primary Encephalitis - The microorganism directly targets and attacks the brain and the spinal cord. c. Eastern Equine Encephalitis - Considered as a serious epidemic disease of the horses. - It affects children under 5 years of age.

Classifications b. Western Equine Encephalitis - Milder form and usually affects adults. c. St. Louise Encephalitis - Microorganism gain entrance through the olfactory tract. d. Japanese Encephalitis - Severe viral disease carried by the vector mosquito, Culex Triteaniorhynchus. - Affects children under 5 to 10

Classifications Secondary Encephalitis - Result as a complication of viral diseases. c. Post Infection Encephalitis - Results as a complication or sequalae of viral diseases like measles, chicken pox, and mumps. b. Post Vaccinal Encephalitis - Most common after receiving anti rabies vaccine.

Classifications Toxic Encephalitis - Caused by ingesting chemical or heavy metals such as lead and mercury.

Causative Agent West Nile Virus

Vector

Mosquito

Host Birds

Incubation Period 5-15 days

POC

As long as microbes are present in the discharges

Mode of Transmissions 1. Vector Borne Transmission 2. Direct Complication 3. Accidental inhalation or ingestion of chemicals

Manifestations Prodromal Period 2. Fever, Headache, Dizziness, Vomiting. 3. Chills, Sore throat, Conjunctivitis, Myalgia, Abdominal pain. Encephalitic Signs 7. Nuchal rigidity, Ataxia, Tremors, Mental confusion, Speech difficulties, Stupor or hyper

Diagnostic Test 1. CSF Analysis - Leuckocytosis - Increase mononuclear pleocytosis - Increase Proteins - Normal or slightly decrease glucose. 2. ELISA IgM 3. Polymerase Chain Reaction Test - Analysis of the virus DNA and

Specific Treatment 1. Acyclovir: Drug of Choice Intravenous 10-21 days Pregnant: 3rd Trimester 2. Anti Convulsant To control seizures 3. Mannitol To decrease cerebral edema 4. Corticosteroid To decrease inflammation

Nursing Management 2. Isolate the patient

3. Follow strict aseptic technique 4. Assess Level of consciousness 5. Check for signs of Increased ICP 6. Provide quite and noise free environment 7. Maintain Fluid balance

Prevention 1. Immunization with MMR 2. CLEAN Program by the DOH C- chemically treated mosquito net L- larvae eating fishes E- environmental sanitation A- anti mosquito lotion N- neem tress such as

PNEUMONIA

Carlo Vincent J. Jordan

Definition Inflammation of the lung parenchyma with the production of alveolar exudates resulting to consolidation of the air sacs.

Causative Agents 1. Streptococcus Pnuemoniae 2. Staphylococcus Aureus 3. Klebsiella Pnuemoniae (Friedlander's Bacilli) 4. Mycoplasma

Incubation Period 1-3 days

Mode of Respiratory Transmission

Droplets Indirect contact with objects contaminated by

Diagnostic Test Chest Xray: confirmatory Sputum C/S

Manifestations Adult: 1. Cough 2. Tachypnea RR>20 breaths per minute 3. Tachycardia CR> 100 beats per minute 4. Fever 37.8C 5. And at least one abnormal findings a. Diminished breath sounds b. Ronchi

Local Measures 1. Isolate the patient 2. Give oral antibiotic DOC: Amoxycillin 1 gm po every hours for 7 days. 3. Give Salbutamol 2mg tablet 3-4 a day. 4. Give Paracetamol 500mg every hours 5. Increase Oral fluid intake 6. Balanced nutrition and exercises 7. Observe for warning signs

8 x 4

Local Measures Warning Signs: 1. Worsening of vital signs a. RR> 30 breaths per minute b. CR> 125 beats per minute c. T> <35C or 40C> 2. Respiratory Failure RR< 12 breaths per minute or cyanosis 3. Evidence of Sepsis Bleeding and Jaundice

Manifestations Pedia 1. Cough 2. Fever 3. Rapid Breathing 2-12 months RR>50 12 months-5 years old RR>40 5 years old- 13 years old RR>30 4. Any of the following abnormal lung sound a. Diminished breath sound b. Ronchi ( Snoring sound) c. Crackles ( short, sharp, rough

Local Measures 1. Give Paracetamol every 4 hours 2. Adequate fluid intake 3. Give oral antibiotics Cotrimoxazole 5mg/kg bid for 5 days Amoxicillin 40-50 mkd tid for 5 days 4. Oral salbutamol 5. Observe for warning signs

Local Measures 5. Observe for warning signs a. Chest indrawing b. Rapid RR>60 c. Irritability/Restlessness d. Poor feeding/Unable to drink e. Persistent vomiting f. Decrease level of consciousness

Local Measures 5. Observe for warning signs a. Chest indrawing b. Rapid RR>60 c. Irritability/Restlessness d. Poor feeding/Unable to drink e. Persistent vomiting f. Decrease level of consciousness REFER to the HOSPITAL

Manifestations Cough and Sputum Production 1. Staphylococcus Aureus - Yellow blood streaked sputum 2. Streptococcal - Rusty Sputum 3. Klebsiella - Red gelatinous sputum 4. Mycoplasma - mucoid sputum: pus + blood

DIPTHERIA

Carlo Vincent J. Jordan

Definition

- An acute, febrile infection of the tonsils, throat, nose, and larynx

Causative Agent Corynebacterium Diptheriae Klebs loeffler bacillus

Incubation Period 2-5 days

Period of 2-4 weeks Communicability Mode of transmission Respiratory droplets Contaminated objects

Causative Agent Corynebacterium Diptheriae Klebs loeffler bacillus Three strains of Corynebacterium a. Gravis- (severe)- Produces the most severe and fatal cases of diphtheria. b. Intermedius- ( intermediate)- more on bleeding manifestations. c. Mitis- (mild)- Produces lesions extending to the larynx and lungs.

Manifestations 1. Nasal Diphtheria - microorganism is localized in the nares - excoriation of the upper lip - PS: Foul smelling serosanginous secretions from the nose 2. Pharyngeal Diphtheria - Fever, malaise - Bull neck appearance of the neck - PS: Pseudomembrane

Manifestations 3. Laryngotracheal Diphtheria - most common in infants - most deadly - signs of respiratory distress - PS: laryngeal stridor: Hoarseness of voice 4. Fever 38C 5. Cervical Adenitis 6. Body weakness 7. DOB

Diagnostic Test 1. Nose and Throat culture 2. Loeffler Slant 3. Moloney’s Test - Determine hypersensitivity to diphtheria toxoid 3. Schick’s Test - Test for susceptibility to diphtheria toxin - Skin testing

Treatment 1. Diphtheria Antitoxin - To combat the toxins secreted by the microorganism 2. Antibiotic: - DOC: Penicillin: to combat causative agent 3. Standby Resuscitative Equipment at the bed side.

Complications 1. Myocarditis caused by action of toxin to heart muscle 2. Polyneuritis that includes; - Paralysis of the soft palate - Paralysis of the ciliary muscle of the eye 3. Airway obstruction 4. Cervical Adenitis 5. Otitis media 6. Bronchopneumonia

Nursing 1. IsolateInterventions and Bed rest for 2

weeks: to conserve energy and decrease workload of the heart. 2. Soft diet: frequent small feedings 3. Increase intake of fruit juices rich in Vitamin C to alkalinize the blood and increase the resistance of the patient 4. Ice collar must be applied to the neck 5. Proper disposal of nasopharyngeal

Pertussis Whooping Cough Carlo Vincent J. Jordan

Definition -

An acute, contagious disease characterized by paroxysmal cough followed by an explosive expiration ending in vomiting.

Causative Agent Bordetella Pertussis. a. Non motile, gram (-) bacillus. b. Easily destroyed by light, heat, and drying

Incubation Period 7-12 days

Period of 7 Communicability days after exposure up

to 3 weeks after paroxysms

Mode of Transmissions Droplets Indirect contact with contaminated objects

Sources of Infection

Secretions from the nose and

Manifestations 1. Catarrhal Stage - Most communicable stage Mucoid rhinoria, Sneezing, Lacrimation, dry bronchial cough . Cough becomes irritating, hacking, and nocturnal and becoming more severe. - Last for 1 to 2 weeks. 2. Paroxysmal Stage - 7th to 14th day - Cough becomes spasmodic and

Manifestations 2. Paroxysmal Stage - Cough ends in a loud, crowing inspiratory whoop and vomiting. - Coughing may induce nose bleeding, increased venous pressure, periorbital edema, conjunctival hemorrhage, hemorrhage of the anterior portion of the eye. - Lasts 4 to 6 weeks

Manifestations 3. Convalescent Stage - Marked by gradual decrease in paroxysms of coughing, vomiting ceases. - Attacks subsides.

Diagnostic Test 1. Nasopharyngeal Swabbing 2. CBC 3. Bordet Gengou Test 4. *Sputum Culture and Sensitivity *Confirmatory diagnostic test

Treatment 1. Fluid and Electrolytes replacement 2. Oxygen Therapy 3. Hyper immune convalescent serum or gamma globulin 4. Antibiotics: Erythromycin and Ampicillin 5. Antitussive : Sinecod Forte

Nursing Intervention 1. Isolate the patient 2. Suctions secretions during the attack to prevent airway obstruction 3. NPO during the attack to prevent aspiration 4. Small frequent feedings 5. Immunization with DPT vaccine